April 18, 2003
Over the past week, medical teams from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) have been visiting hospitals in a number of cities in Iraq to assess the most urgent needs and to find ways to meet them. The surgical team in Baghdad has continued to help in one of the hospitals there with the workload of the emergency department. Other MSF volunteers have been visiting and offering assistance to some of the other hard-pressed medical facilities in the city. Meanwhile, mobile teams have been traveling to Basra, Karballah, Al Hillah, Al Najaf, Al Nasariya, Al Qut, and Mosul.
These were very rapid assessments and they may not be representative of the whole country. The results are summarized below. The exploration is continuing and MSF will report on conditions as we find them. MSF as been carrying out this work completely independently of the coalition military forces and believes that it is essential that truly impartial humanitarian agencies are present and active to offer support to the Iraqi people and medical staff.
MSF's Recent Medical Surveys:
At Al Yarmouk Hospital, which was bombed 10 days ago, only the emergency department is operating. Thursday was its first day back at work. There is a serious lack of nursing staff and a very limited supply of essential drugs. Much of their medical equipment was also looted. The management of the hospital is finding it difficult to cope. Only one generator out of three is running, which means that the kidney dialysis machine is only working for part of the day. The staff are having to turn patients away to other hospitals.
Karameh Hospital on the west bank of the river has around 450 beds and is continuing to work effectively. The staff found ways to guard the hospital and there was no looting. There were not many material needs here but there was concern about insecurity in the wider city that was discouraging staff from traveling and returning to work.
The Pediatric Hospital had very limited treatment capacity.
MSF's surgical team has continued to work in the Zafarinia hospital, where they have been helping with routine operations: ovarian cyst, appendicitis, limb injuries.
MSF delivered drug supplies, particularly painkillers, and some surgical materials to these hospitals where there were clear needs and requests.
The MSF Medical Coordinator in Baghdad summarized the overall problems as follows.
1) Many patients - possibly thousands - were discharged to their homes after initial surgery due to insecurity. Some will need secondary surgery. It is currently impossible to get an overview of the remaining surgical needs.
2) Some patients with chronic medical diseases, such as kidney disease (no dialysis machines working well), diabetes (no refrigerators to store insulin), cardiovascular diseases (no drugs, no medical attention, no pharmacies open) will have serious problems.
3) There are 34 hospitals in Baghdad, with about a half of them are believed to be functioning. The few we have seen are generally under great stress with organization and management often limited. Patients are being taken care of but the quality of care may be far from optimal. Moreover, most people do not know which hospitals are functioning or where to go if they are ill.
4) Many hospitals were looted but the ones now more or less open seem to have enough medical supplies, apart from specific items such as anesthesia drugs and external fixations. There is still insufficient information about stocks.
5) There is a lack of public transport due to insecurity and lack of petrol. Staff in the hospitals, especially nursing staff, are not coming to work. Patients are not coming in the numbers we should expect due to the same transport problem. So the low number of admissions we see in the hospitals is probably not a true indication of the need for emergency treatment.
6) The administration and the security of hospitals is in flux.
The Surgical Hospital's structure was intact and appeared to be functioning reasonably well. There were some shortages of nursing staff and requests for painkillers, external fixators, colostomy bags, and suture materials. During the height of the fighting in the area, the hospital staff say they had 450 surgical cases.
The Hospital of Internal Medicine with 200 beds appeared to be working well.
Electricity and water supplies were available in the town. There are 76 health centers in the area and the local authorities expect to have reports from all of them shortly.
The overall Ministry of Health structure is still in place in the city. The 5 hospitals deliver 1,000 beds for the million people in the governerate and there are 37 health care centers operational. The main city hospital has local armed guards. There were no obvious medical needs or emergency. requirements.
8 hospitals and 32 clinics. Some shortages of specific drugs. For example, endemic kala azar has taken more lives recently because the treatment drugs were exhausted. There are shortages of oxygen. However, water and electricity are reaching the medical facilities and the staff report that there were only 17 war wounded from the period of intense fighting near the town.
The two main hospitals in town were visited yesterday: al Zahwari surgical teaching hospital and Saddam teaching hospital. They have several hundreds beds each. There was no sign of war damage or looting and the water and electricity services were functioning. Some 400 wounded had been treated since the beginning of the war, 25 in the past week of clashes in the town. There were staff working and drugs available. We were told of some shortage of anesthetic drugs. The MSF team is continuing to visit other health structures in the city.
The medical service is the only civil structure within Basra that is functioning at this point. There are currently 4 functional hospitals within Basra city, though they are not operating at their previous level due to staffing shortages and equipment. Two of the 4 teaching hospitals have been reported to be looted. There has been an increase in diarrheal cases. Small water tankers and individuals are collecting water directly from the river and the Directorate of Health has stated that the hospital is not receiving enough water. The water supply is limited by the power problem.
More than half of the Primary Healthcare Centers are currently working, many of others have been damaged or had material stolen during the lootings. Local sources say that the lack of protein is a nutritional problem.
An MSF emergency medical team visited the main hospital of the Karbala Governate earlier this week.
MSF found that the senior doctors of the hospital have reacted to the recent upheaval in a professional manner: steps were taken to ensure the safe storage of drugs and medical material, while doctors and medical staff have carried on with their regular work as much as the circumstances have allowed. So, although they spoke of some specific drug shortages, they were generally well supplied. Security and electricity problems still need to be overcome to limit any threat to the medical facilities. MSF remains in contact with the hospital to provide what support may be necessary.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)